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Zhang D, Halim A, FitzPatrick S, Fishman F. The Ethics of International Medical Tourism. J Bone Joint Surg Am 2024; 106:845-849. [PMID: 38512982 DOI: 10.2106/jbjs.23.00873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Affiliation(s)
- Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Andrea Halim
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
| | | | - Felicity Fishman
- Stritch School of Medicine, Loyola University, Maywood, Illinois
- Shriners Children's Chicago, Chicago, Illinois
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Potin M, Carron PN, Genton B. Injuries and medical emergencies among international travellers. J Travel Med 2024; 31:taad088. [PMID: 37405992 DOI: 10.1093/jtm/taad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Tropical infectious diseases and vaccine-preventable emergencies are the mainstay of pre-travel consultations. However, non-communicable diseases, injuries and accidents that occur during travel are not emphasized enough in these settings. METHODS We performed a narrative review based on a literature search of PubMed, Google Scholar, UpToDate, DynaMed and LiSSa and on reference textbooks and medical journals dedicated to travel, emergency and wilderness medicine. Relevant secondary references were extracted. We also aimed to discuss newer or neglected issues, such as medical tourism, Coronavirus Disease 2019, exacerbations of co-morbidities associated with international travel, insurance coverage, health care seeking abroad, medical evacuation or repatriation and tips for different types of travellers' emergency medical kits (personal, group, physician handled). RESULTS All sources reviewed led to the selection of >170 references. Among epidemiological data on morbidity and deaths while abroad, only retrospective data are available. Deaths are estimated to occur in 1 in 100 000 travellers, with 40% caused by trauma and 60% by diseases, and <3% linked to infectious diseases. Trauma and other injuries acquired during travel, such as traffic accidents and drowning, can be reduced by up to 85% with simple preventive recommendations such as avoiding simultaneous alcohol intake. In-flight emergencies occur on 1 in 604 flights on average. Thrombosis risk is two to three times greater for travellers than for non-travellers. Fever during or after travel can occur in 2-4% of travellers, but in up to 25-30% in tertiary centres. Traveller's diarrhoea, although rarely severe, is the most common disease associated with travel. Autochthonous emergencies (acute appendicitis, ectopic pregnancy, dental abscess) can also occur. CONCLUSIONS Pre-travel medicine encounters must include the topic of injuries and medical emergencies, such as the risk-taking behaviours and foster better planning in a comprehensive approach along with vaccines and infectious diseases advices.
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Affiliation(s)
- Mathieu Potin
- ISTM CTH (Certificate of Travel Health), Chemin des Croix-Rouges 12, Lausanne CH-1007, Switzerland
| | - Pierre-Nicolas Carron
- Emergency Department, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, Lausanne CH-1011, Switzerland
| | - Blaise Genton
- Policlinic of Tropical, Travel Medicine and Vaccination, Centre for Primary Care and Public Health, Unisanté, University of Lausanne, Rue du Bugnon 44, Lausanne CH-1011, Switzerland
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Brackett A, McCarthy E, Ji W, Hanlon A, Ellis R, Getchell J, Halbert C. Safety and feasibility of destination care for bariatric surgery: a single institution retrospective study. Surg Endosc 2023; 37:9609-9616. [PMID: 37884733 DOI: 10.1007/s00464-023-10501-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/24/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Increasing emphasis on value-based healthcare has prompted both employers and healthcare organizations to develop innovative strategies to supply high quality care to patients. One such strategy is through the bundled care payment model (BCPM). Through this model, our institution partnered with employers from across the country to provide quality care for their members. Patients traveling greater than 2 h driving time from the bariatric center were considered "destination" patients. To properly care for our destination patients, our institution created a "destination bariatric program." We sought to investigate comparative outcomes for the first 100 patients who completed the program. We hypothesized that there would be no difference in patient outcomes or complications between destination and local patient groups undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). METHODS AND PROCEDURES A retrospective cohort analysis of patients undergoing bariatric surgery at a MBSAQIP-accredited bariatric surgery center between May 2019 and October 2021 was conducted. Patients were divided into destination or local patient groups based on participation in the established destination surgery program. Patient demographics, perioperative clinical outcomes, and complications were compared and statistically analyzed using two-sample t-tests, Chi-square tests, Fisher's exact tests, and univariate logistic regressions. RESULTS This study identified 296 patients, which consisted of destination (n = 110) and local (n = 186) patient cohorts. Patients in the destination group had higher rates of diabetes mellitus (29.1% vs 24.2%, p = 0.029), but otherwise cohorts had similar basic demographics and comorbidities. Outcomes revealed no statistically significant associations between patient cohort (destination versus local) and ED admission (p = 0.305), hospital readmission (p = 0.893), surgical reintervention (p = 0.974), endoscopic-reintervention (p = 0.714), and patient complications in the postoperative period (30 days). CONCLUSION Participation in destination care programs for bariatric surgery was found to be both safe and feasible. These destination programs represent an opportunity to provide a broader patient population access to complex surgical care.
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Affiliation(s)
- Arielle Brackett
- Christiana Care Health System, 4755 Ogletown Stanton Road, Newark, DE, 19718, USA
| | - Elizabeth McCarthy
- Christiana Care Health System, 4755 Ogletown Stanton Road, Newark, DE, 19718, USA
| | - Wenyan Ji
- Virginia Polytechnic Institute and State University, Center for Biostatistics and Health Data Science, Four Riverside Circle, Roanoke, VA, 24016, USA
| | - Alexandra Hanlon
- Virginia Polytechnic Institute and State University, Center for Biostatistics and Health Data Science, Four Riverside Circle, Roanoke, VA, 24016, USA
| | - Robin Ellis
- Christiana Care Health System, 4755 Ogletown Stanton Road, Newark, DE, 19718, USA
| | - John Getchell
- Christiana Care Health System, 4755 Ogletown Stanton Road, Newark, DE, 19718, USA
| | - Caitlin Halbert
- Christiana Care Health System, 4755 Ogletown Stanton Road, Newark, DE, 19718, USA.
- , 501 West 14th Street, Wilmington, DE, 19802, USA.
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Gilardi R, Galassi L, Del Bene M, Firmani G, Parisi P. Infective complications of cosmetic tourism: A systematic literature review. J Plast Reconstr Aesthet Surg 2023; 84:9-29. [PMID: 37320953 DOI: 10.1016/j.bjps.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 04/16/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Cosmetic tourism has increased dramatically over the years. We performed a systematic review of the literature to find reports of infective complications following cosmetic surgery, focusing on epidemiology, clinical, and surgical management. In addition, we identified cosmetic tourism trends in terms of mobilization from the country of origin and travel destinations. METHODS A search on PubMed, Embase, and Web of Science was performed between March and August 2022. The search was not restricted based on study date. Only English manuscripts were assessed. Reviews, short communications, letters, and correspondences were excluded after reviewing their references for potentially relevant studies. Articles related to non-cosmetic surgeries were also excluded from the study. RESULTS We identified 152 articles, of which 31 were duplicates and 47 were excluded based on title/abstract assessment. Three non-English manuscripts, 13 reviews, 12 letters to the editor, and 10 articles that did not feature clinical cases were also rejected. Thirty-six articles were included for analysis. We found 370 patients with infective complications following cosmetic surgery. The severity of complications was stratified according to the Clavien-Dindo classification. Most reports were from the United States (56.5%), followed by Switzerland and the United Kingdom. Travel destinations included the Dominican Republic (34.3%), Turkey, and Colombia. CONCLUSION Infective complications commonly occurred after abdominoplasties in patients who underwent cosmetic surgeries in Latin America or Asia. Most infective complications required management with surgical procedures that involved the administration of local, regional, or general anesthesia. Gluteal augmentations were the fourth most common cosmetic procedures; however, they were associated with the highest number of severe cases, which required intensive care treatment.
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Affiliation(s)
- Roberta Gilardi
- Division of Plastic & Reconstructive Surgery, San Gerardo Hospital of Monza, Italy
| | - Luca Galassi
- Division of Vascular Surgery, San Gerardo Hospital of Monza, Italy
| | - Massimo Del Bene
- Division of Plastic & Reconstructive Surgery, San Gerardo Hospital of Monza, Italy
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sapienza University of Rome - Department of Plastic Surgery Sant'Andrea Hospital, Rome, Italy
| | - Paola Parisi
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS Rome, Italy.
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Bopp TC, Marchesi M, Zihlmann R, Sax H, Wolfensberger A. Identifying patients at high risk for multidrug-resistant organisms after hospitalization abroad. Infect Control Hosp Epidemiol 2023; 44:1281-1288. [PMID: 36912341 DOI: 10.1017/ice.2022.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
OBJECTIVES We quantified the percentage of multidrug-resistant organism (MDRO) carriers among repatriated patients. We identified factors associated with MDRO carriage, and we evaluated the yield of MDRO detection per screened body site. DESIGN Retrospective cohort study. SETTING A tertiary-care center in Switzerland. PATIENTS Adult patients after a stay in a healthcare institution abroad. METHODS Patients were screened for MDRO carriage. Standard sites, including nose and throat, groins, and (since mid-2018) rectum, and risk-based sites (wounds, urine, tracheal secretion) were sampled. MDROs were defined as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), extended-spectrum β-lactamase (ESBL)- and carbapenemase-producing Enterobacterales (CPE), multidrug-resistant (MDR) Enterobacterales, and MDR nonfermenting gram-negative rods. Risk factors for MDRO carriage were assessed using multivariate logistic regression. RESULTS Between May 2017 and April 2019, 438 patients were screened and 107 (24.4%) tested positive for an MDRO, predominantly ESBL-producing and MDR Enterobacterales. Risk factors for MDRO colonization were the length of stay in hospital abroad, antibiotic treatment with 'Watch' and 'Reserve' antibiotics, and region of hospitalization abroad. Rectal swabs had the highest yield for detecting patients with MDR intestinal bacteria, but nose/throat and groins, or wound samples were more sensitive for MRSA or nonfermenting gram-negative organisms, respectively. CONCLUSIONS We identified risk factors for MDRO carriage and body sites with the highest yield for a specific MDRO, which might help to target screening and isolation and reduce screening costs.
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Affiliation(s)
- Tamara C Bopp
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Martina Marchesi
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Reto Zihlmann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
- Seminar for Statistics, ETH Zurich, Zurich, Switzerland
| | - Hugo Sax
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Aline Wolfensberger
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
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Piyaphanee W, Stoney RJ, Asgeirsson H, Appiah GD, Díaz-Menéndez M, Barnett ED, Gautret P, Libman M, Schlagenhauf P, Leder K, Plewes K, Grobusch MP, Huits R, Mavunda K, Hamer DH, Chen LH. Healthcare seeking during travel: an analysis by the GeoSentinel surveillance network of travel medicine providers. J Travel Med 2023; 30:taad002. [PMID: 36637429 PMCID: PMC10979637 DOI: 10.1093/jtm/taad002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND International travellers may seek care abroad to address health problems that arise during their trip or plan healthcare outside their country of residence as medical tourists. METHODS Data were collected on travellers evaluated at GeoSentinel Network sites who reported healthcare during travel. Both unplanned and planned healthcare were analysed, including the reason and nature of healthcare sought, characteristics of the treatment provided and outcomes. Travellers that presented for rabies post-exposure prophylaxis were described elsewhere and were excluded from detailed analysis. RESULTS From May 2017 through June 2020, after excluding travellers obtaining rabies post-exposure prophylaxis (n= 415), 1093 travellers reported care for a medical or dental issue that was an unanticipated part of the travellers' planned itinerary (unplanned healthcare). Travellers who sought unplanned healthcare abroad had frequent diagnoses of acute diarrhoea, dengue, falciparum malaria and unspecified viral syndrome, and obtained care in 131 countries. Thirty-four (3%) reported subsequent deterioration and 230 (21%) reported no change in condition; a third (n = 405; 37%) had a pre-travel health encounter. Forty-one travellers had sufficient data on planned healthcare abroad for analysis. The most common destinations were the US, France, Dominican Republic, Belgium and Mexico. The top reasons for their planned healthcare abroad were unavailability of procedure at home (n = 9; 19%), expertise abroad (n = 9; 19%), lower cost (n = 8; 17%) and convenience (n = 7; 15%); a third (n = 13; 32%) reported cosmetic or surgical procedures. Early and late complications occurred in 14 (33%) and 4 (10%) travellers, respectively. Four travellers (10%) had a pre-travel health encounter. CONCLUSIONS International travellers encounter health problems during travel that often could be prevented by pre-travel consultation. Travellers obtaining planned healthcare abroad can experience negative health consequences associated with treatments abroad, for which pre-travel consultations could provide advice and potentially help to prevent complications.
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Affiliation(s)
- Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rhett J. Stoney
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Unit of Infectious Diseases, Department of Medicine Huddinge, Stockholm Sweden
| | - Grace D. Appiah
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marta Díaz-Menéndez
- Tropical and Travel Medicine Unit, RICET, Hospital La Paz-Carlos III, Madrid, Spain
| | - Elizabeth D. Barnett
- Section of Pediatric Infectious Diseases, Boston Medical Center; Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille; IHU-Méditerranée Infection, Marseille, France
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada
| | - Patricia Schlagenhauf
- University of Zürich Centre for Travel Medicine, WHO Collaborating Centre for Travellers’ Health, Zürich, Switzerland
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University; Victorian Infectious Disease Service, Royal Melbourne Hospital at the Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Katherine Plewes
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ralph Huits
- Department of Infectious Tropical diseases and Microbiology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | | | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine; Center for Emerging Infectious Diseases Research and Policy, Boston University, Boston, MA, USA
| | - Lin H. Chen
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge; Harvard Medical School, Boston, MA, USA
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Hummel CE, Klein HJ, Giovanoli P, Lindenblatt N. Complications arising from aesthetic surgery procedures in foreign countries and Switzerland. Swiss Med Wkly 2023; 153:40077. [PMID: 37186084 DOI: 10.57187/smw.2023.40077] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Cosmetic surgery tourism has increased in popularity in recent years, with arising complications and post-operative follow-up care often managed in the client's home country, thereby burdening the Swiss health care system. METHODS We retrospectively reviewed patients with complications after cosmetic surgeries abroad and in Switzerland who were treated at the University Hospital Zurich between 2015 and 2019. Data were collected from medical records and reviewed for patient characteristics, procedures, complications, and treatment modalities. RESULTS A total of 228 patients (207 females and 21 males) were identified with female mean age of 40.9±12.0 years and male mean age of 34.3±8.9 years. Most complications were observed for procedures performed in Europe (69%) with only thirty-six patients (16%) experiencing complications due to a procedure undertaken in Switzerland. Breast surgery was the most frequently performed procedure (60%), followed by body contouring (17%) and facial surgery (12%). The most common complications occurring after surgeries abroad were pain and discomfort (19%) as well as aesthetic dissatisfaction (18%), followed by wound breakdown (14%) and infection (11%). Most patients (76%) were treated as outpatients and the treatment of all patients over the observed period cost the healthcare system $ 795,574. CONCLUSIONS There is an ongoing trend of cosmetic surgery tourism leading to an increasing number of patients with complications requiring aftercare in Switzerland. In contrast to previous research, more men are seeking cosmetic surgery abroad and the most common complications, such as wound healing disorders and infection, descreased in favor of aethetic dissatisfaction, possibly indicating ameliorated patient aftercare abroad.
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Affiliation(s)
- Carmen E Hummel
- Department of Plastic Surgery and Hand Surgery, Kantonsspital Winterthur, Switzerland
| | - Holger J Klein
- Department of Plastic Surgery and Hand Surgery, Kantonsspital Aarau, Switzerland
| | - Pietro Giovanoli
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Switzerland
| | - Nicole Lindenblatt
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Switzerland
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Descriptive Analysis of International Bariatric Surgery Tourism Services. Obes Surg 2023; 33:1300-1303. [PMID: 36826678 PMCID: PMC10079712 DOI: 10.1007/s11695-023-06522-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
Inadequate access to public bariatric surgical services has favoured the growth of bariatric tourism. This study analysed data extracted from bariatric surgical centres that care for patients travelling from abroad. The research highlights apparent deficits in accreditation, communication, perioperative care, and travel health advice. An international registry of accredited bariatric tourism providers and patient education may be indicated.
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Heinz T, Eidmann A, Jakuscheit A, Laux T, Rudert M, Stratos I. Demographics and Trends for Inbound Medical Tourism in Germany for Orthopedic Patients before and during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1209. [PMID: 36673964 PMCID: PMC9859416 DOI: 10.3390/ijerph20021209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/28/2022] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
Medical tourism is a rapidly growing sector of economic growth and diversification. However, data on the demographics and characteristics of the traveling patients are sparse. In this study, we analyzed the common demographic properties and characteristics of the inbound medical tourists seeking orthopedic medical care in Germany for the years 2010 to 2019 compared to a domestic group. At the same time, we examined how the COVID-19 pandemic outbreak of 2020 changed the field of medical tourism in Germany. Calculations were performed using administrative hospital data provided by the Federal Statistical Department of Germany. Data were analyzed from the years 2010 to 2020. A total of six elective orthopedic surgery codes (bone biopsy, knee arthroplasty, foot surgery, osteotomy, hardware removal, and arthrodesis) were identified as key service indicators for medical tourism and further analyzed. Factors including residence, sex, year, and type of elective surgery were modeled using linear regression analysis. Age and sex distributions were compared between patients living inside Germany (DE) or outside Germany (non-DE). Between 2010 and 2020, 6,261,801 orthopedic procedures were coded for the DE group and 27,420 key procedures were identified for the non-DE group. Medical tourists were predominantly male and significantly younger than the domestic population. The linear regression analysis of the OPS codes over the past years showed a significantly different slope between the DE and non-DE groups only for the OPS code "hardware removal". With the COVID-19 pandemic, an overall decline in performed orthopedic procedures was observed for the non-DE and the DE group. A significant reduction below the 95% prediction bands for the year 2020 could be shown for hardware removal and foot surgery (for DE), and for hardware removal, knee arthroplasty, foot surgery, and osteotomy (for non-DE). This study is the first to quantify inbound medical tourism in elective orthopedic surgery in Germany. The COVID-19 pandemic negatively affected many-but not all-areas of orthopedic surgery. It has to be seen how this negative trend will develop in the future.
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Affiliation(s)
- Tizian Heinz
- Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany
| | - Annette Eidmann
- Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany
| | - Axel Jakuscheit
- Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany
| | - Tino Laux
- Distance and Independent Studies Center, Technical University Kaiserslautern, Erwin-Schroedinger-Straße 57, 67663 Kaiserslautern, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany
| | - Ioannis Stratos
- Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany
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McLean L, Ros ST, Hollond C, Stofan J, Quinn GP. Patient and clinician experiences with cross-border reproductive care: A systematic review. PATIENT EDUCATION AND COUNSELING 2022; 105:1943-1952. [PMID: 35339328 DOI: 10.1016/j.pec.2022.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This review analyzes the experiences of patients and clinicians with regards to international cross-border reproductive care (CBRC) for the purpose of conception. METHODS Electronic databases PubMed, Embase, Web of Science, and Scopus were searched using 'medical tourism' AND 'assisted reproductive technology' from 1978 to 2020. RESULTS Predominant patient motivators for CBRC were cost and legality of assisted reproduction technology (ART) in one's home country, followed by cultural factors like shared language, religion, and cultural familiarity. Clinicians suggested global laws for CBRC would reduce the potential for exploitation of vulnerable populations but believed the enactment of international regulations unlikely and, even if enacted, difficult to enforce. CONCLUSIONS While patient and clinician experiences with CBRC varied, patients frequently cited financial and legal reasons for pursuing CBRC, while many providers had concern for the patient's safety. CLINICAL PRACTICE IMPLICATIONS This review recommends clinicians involved in family planning counsel patients seeking treatment abroad by: (i) informing patients of the risks and benefits of treatment abroad, (ii) establishing guidelines and standards for clinicians on resuming patient care post-CBRC, and (iii) creating a directory of reputable CBRC clinicians and experts.
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Affiliation(s)
- Laura McLean
- Morsani College of Medicine, University of South Florida, Tampa, USA.
| | - Stephanie T Ros
- Morsani College of Medicine, University of South Florida, Tampa, USA
| | | | - Jordan Stofan
- Morsani College of Medicine, University of South Florida, Tampa, USA
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Couceiro J, Elger BS, Satalkar P. Stakeholder perspectives on ‘Swiss quality’ healthcare in the context of inbound medical tourism to Switzerland: An exploratory qualitative study. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2022. [DOI: 10.1177/25160435221102124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Global literature on medical travel focuses on patients from high-income countries traveling to middle-income countries reputed for providing high quality care at significantly lower costs. However, little is known about the movement of wealthy foreign patients to high-income countries such as the USA, the UK or Switzerland. Objective In this paper, we focus on Swiss medical tourism stakeholders and their strategies to attract a niche of self-paying foreign patients to undergo medical treatment in Switzerland. We describes how they harness the label of ‘Swiss quality’ healthcare to promote Switzerland in global medical travel industry. Methods We conducted semi-structured, in-depth interviews with 30 medical tourism stakeholders including 15 healthcare professionals (HCPs) treating self-paying foreign patients in publicly funded and privately owned hospitals in French- and German-speaking regions of Switzerland. The data were inductively coded using thematic analysis. Results We present their views on ‘Swiss quality’ healthcare under three themes: health-related human resources, Swiss medical infrastructure, and foreign patients’ perceived trust in the ‘Swiss quality’ label. Participants equated Switzerland's global image and ‘Swiss quality’ as a ‘brand’ and believed that foreign patients’ trust in ‘Swiss quality’ is a unique selling point of Swiss healthcare system. Conclusion By problematizing the use of ‘Swiss quality’ label to attract wealthy patients to Switzerland, we highlight a few ethical questions that deserve further scrutiny.
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Affiliation(s)
- João Couceiro
- University of Basel Institute for Biomedical Ethics, Basel, Switzerland
| | - Bernice S. Elger
- University of Basel Institute for Biomedical Ethics, Basel, Switzerland
| | - Priya Satalkar
- University of Basel Institute for Biomedical Ethics, Basel, Switzerland
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Rafeh S, Tara M C, Michael F, Amy G, Elaf O, Paul R, James O, Aidan M, Seamus M, Gerrard O. An analysis of the cost and impact of cosmetic tourism and its associated complications: A multi institutional study. Surgeon 2022; 20:339-344. [PMID: 35012867 DOI: 10.1016/j.surge.2021.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/05/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE The increasing cost of cosmetic procedures, long elective waiting times in the public system and affordability of procedures offered abroad has driven the rapid growth of cosmetic tourism. The incidence and cost of patients presenting to the Irish health service with complications related to cosmetic procedures carried out in overseas institutions is largely unknown. This heterogenous group of patients is challenging to identify. Limited data exists for this patient group in the Irish context. We aimed to perform a multicentre audit and cost analysis of patients presenting to Irish health services with complications related to cosmetic procedures performed in overseas institutions over a 2 year period. METHODS Patients presenting to two University Hospitals from March 2019-April 2021 with complications after a cosmetic surgical procedure was performed abroad were studied. The HPO ABF 2020 price list data was used to calculate the inpatient and procedure cost for each subject. MAIN FINDINGS 14 (13/92.8% female, mean age 43 ± 11.85 years) patients presented during the study period. Countries of cosmetic operation included: Belgium (6/46.2%), the UK (2/15.4%), Latvia, Turkey, Poland, Lithuania, and Estonia (1 patient/7.7% each country). All required a re-operative procedure. These interventions included: removal of infected implant (n = 1), adjustment or removal of a gastric band (n = 9) and debridement of an infected/necrotic wound (n = 3). Mean length of stay was 9.14 ± 7.48 (range 2-28) days. Five (38.4%) patients required vac dressing. The mean cost of the cohort for the interventional procedure and in-patient stay was €15912.53 (+/- €6388). The sum total of all the costs for the cohort was €231038.60. CONCLUSIONS Significant costs were associated with prolonged hospital admissions, operative interventions, intravenous antibiotics, VAC dressing application and follow up visits. Complications from procedures performed in overseas institutions account for a significant cost burden to health services in Ireland.
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Affiliation(s)
- Saeed Rafeh
- Department of Breast and General Surgery, University Hospital Waterford, Waterford, Ireland.
| | - Connelly Tara M
- Department of Colorectal and General Surgery, University Hospital Waterford, Waterford, Ireland.
| | - Flanagan Michael
- Department of Breast and General Surgery, University Hospital Waterford, Waterford, Ireland.
| | - Gillis Amy
- Department of Surgical Oncology, Tallaght University Hospital, Dublin, 24, Ireland.
| | - Osman Elaf
- Department of Breast and General Surgery, University Hospital Waterford, Waterford, Ireland.
| | - Ridgway Paul
- Department of Surgical Oncology, Tallaght University Hospital, Dublin, 24, Ireland.
| | - O'Riordan James
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin, 24, Ireland.
| | - Manning Aidan
- Department of Breast and General Surgery, University Hospital Waterford, Waterford, Ireland.
| | - Murphy Seamus
- Department of Breast and General Surgery, University Hospital Waterford, Waterford, Ireland.
| | - O'Donoghue Gerrard
- Department of Breast and General Surgery, University Hospital Waterford, Waterford, Ireland.
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13
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Kamel S, Smith KR. Stem-cell clinics in the UK: a web-based study. Regen Med 2021; 16:1029-1036. [PMID: 34761690 DOI: 10.2217/rme-2021-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Explore the nature and extent of web-based promotion of stem cell treatments marketed by clinics in the UK. Materials & methods: Web-based analysis of clinics in the UK using predefined variables, with analysis of eligible clinics according to preset criteria of ethical relevance. Results: A majority (79%) of UK clinics were judged to be problematic. Information was found to be lacking, misleading or otherwise problematic in several respects, including a lack of information on risks of adverse effects, unjustifiably optimistic depictions of therapeutic effectiveness, and questionable presentational approaches such as the use of celebrity patient testimonials. Conclusion: In a majority of cases, commercial clinics in the UK portray stem-cell therapies on their websites in ethically questionable ways.
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Affiliation(s)
- Sami Kamel
- Division of Health Science, School of Applied Sciences, Abertay University, Dundee, DD1 1HG, UK
| | - Kevin R Smith
- Division of Health Science, School of Applied Sciences, Abertay University, Dundee, DD1 1HG, UK
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14
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Waterer G, Pickens CI, Wunderink R. Antibiotic-resistant bacteria: COVID-19 hasn't made the challenge go away. Respirology 2021; 26:1024-1026. [PMID: 34596927 PMCID: PMC8661559 DOI: 10.1111/resp.14166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Grant Waterer
- Faculty of Medicine, University of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia
| | | | - Richard Wunderink
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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15
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Şekercan A, Harting J, Peters RJG, Stronks K. Understanding transnational healthcare use in immigrant communities from a cultural systems perspective: a qualitative study of Dutch residents with a Turkish background. BMJ Open 2021; 11:e051903. [PMID: 34593502 PMCID: PMC8487186 DOI: 10.1136/bmjopen-2021-051903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Transnational utilisation of healthcare by people with an immigrant background carries risks, including medicalisation and adverse iatrogenic outcomes. We investigated the drivers behind such transnational healthcare use from a cultural perspective on health systems. DESIGN Qualitative interview study (2018). SETTING Two primary care practices in Amsterdam, the Netherlands. PARTICIPANTS Thirteen Dutch patients of Turkish background, who had obtained healthcare in Turkey, and who in general visited the primary care practice more than once a month. RESULTS In the respondents' stories, we observed how: (1) cross-border healthcare use was encouraged by cultural mismatches between expected and provided services and by differing explanatory models of illness upheld by patients and Dutch providers; (2) both transnationalism in patients and entitlements to insurance reimbursement facilitated the use of Turkish health services to bypass perceived barriers in the Dutch system; (3) cultural mismatches were reinforced during general practitioner consultations after the patients' return to the Netherlands, thereby inducing further service use abroad. CONCLUSIONS Although cultural system influences are difficult to bridge, measures to reduce the unwelcome consequences of transnational healthcare use may include (1) strengthening the provision of culturally sensitive care in the country of residence and (2) restricting the reimbursement of care in the country of origin while maintaining the option to obtain care abroad.
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Affiliation(s)
- Aydin Şekercan
- Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Janneke Harting
- Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Ron J G Peters
- Cardiology, Amsterdam UMC, Location AMC, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Karien Stronks
- Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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16
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Rofaiel DP, Hession P, Flaherty GT. Analysis of web-based travel health advice provided to international travellers with chronic medical and psychiatric illnesses. Int J Med Inform 2021; 154:104566. [PMID: 34520934 DOI: 10.1016/j.ijmedinf.2021.104566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The internet is an important source of travel health information. Individuals living with chronic illnesses consult patient organisation websites for illness-related information. We analysed the scope of online travel health information available to patients with pre-existing medical conditions. STUDY DESIGN A descriptive content analysis of patient organisation websites was conducted. METHODS The Google® search engine was interrogated using search terms related to the principal chronic diseases from the Global Burden of Disease Study. Data relating to 41 travel health variables were extracted from each eligible website. An aggregate quality score was derived for each organisation based on the presence of specific website information. Visitor usage and search analytics for each organisation's website were also described. RESULTS We examined 145 official organisation websites relating to 10 major chronic illnesses. The largest number of websites was retrieved for patients with cancer (n = 36). Only 21 (16.5%) websites provided information on fitness-to-travel considerations. COPD websites had the highest average quality score (17.68%), followed by diabetes (14.91%) and dementia (13.28%). Mental health illness websites had the lowest score of 1.33%. There was a trend towards increased emphasis on pre-travel preparation and medications. Insect bite avoidance, malaria, animal bites, jet lag, and repatriation were addressed to the least extent. CONCLUSIONS Our analysis exposes significant deficits in the coverage of travel health topics. Patient organisations should provide accessible pre-travel health advice to website users. Future research should elucidate the influence of web-based pre-travel health information on the behaviour of travellers with chronic disease.
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Affiliation(s)
- David P Rofaiel
- School of Medicine, National University of Ireland Galway, Galway, Ireland; National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Paul Hession
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Gerard T Flaherty
- School of Medicine, National University of Ireland Galway, Galway, Ireland; National Institute for Prevention and Cardiovascular Health, Galway, Ireland; School of Medicine, International Medical University, Kuala Lumpur, Malaysia.
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17
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Baba H, Kanamori H, Katsumi M, Sato T, Chida T, Ikeda S, Suzuki Y, Yano H, Tokuda K. A case of meningitis due to extensively drug-resistant Pseudomonas aeruginosa imported through medical evacuation: genomic and environmental investigation. J Travel Med 2021; 28:6185116. [PMID: 33763694 DOI: 10.1093/jtm/taab047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Hiroaki Baba
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.,Department of Intelligent Network for Infection Control, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Hajime Kanamori
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.,Department of Intelligent Network for Infection Control, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.,Division of Infection Control, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Makoto Katsumi
- Department of Laboratory Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Apba-ku, Sendai, Miyagi 980-8574, Japan
| | - Takami Sato
- Division of Infection Control, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.,Department of Laboratory Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Apba-ku, Sendai, Miyagi 980-8574, Japan
| | - Takae Chida
- Division of Infection Control, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Shinobu Ikeda
- Division of Infection Control, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Yuki Suzuki
- Department of Microbiology and Infectious Diseases, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara 634-8521, Japan
| | - Hisakazu Yano
- Department of Microbiology and Infectious Diseases, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara 634-8521, Japan
| | - Koichi Tokuda
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.,Department of Intelligent Network for Infection Control, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.,Division of Infection Control, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
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18
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Lyons S, Salgaonkar S, Flaherty GT. International stem cell tourism: a critical literature review and evidence-based recommendations. Int Health 2021; 14:132-141. [PMID: 34415026 PMCID: PMC8890798 DOI: 10.1093/inthealth/ihab050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 01/08/2023] Open
Abstract
Stem cell tourism is an emerging area of medical tourism activity. Frustrated by the slow translation of stem cell research into clinical practice, patients with debilitating conditions often seek therapeutic options that are not appropriately regulated. This review summarises recent developments in the field of stem cell tourism and provides clinicians with the information necessary to provide basic pretravel health advice to stem cell tourists. PubMed and Scopus databases were consulted for relevant publications, using combinations of the terms 'stem cell', 'tourism', 'regenerative medicine', 'international', 'travel medicine' and 'environmental health'. The leading countries in the international stem cell tourism market are the USA, China, India, Thailand and Mexico. As the majority of clinics offering stem cell therapies are based in low- and-middle-income countries, stem cell tourists place themselves at risk of receiving an unproven treatment, coupled with the risk of travel-related illnesses. These clinics do not generally provide even basic travel health information on their websites. In addition to often being ineffective, stem cell therapies are associated with complications such as infection, rejection and tumorigenesis. Physicians, researchers, regulatory bodies, advocacy groups and medical educators are encouraged to work together to improve patient and physician education and address current legislative deficiencies.
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Affiliation(s)
- Samantha Lyons
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Ireland.,Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Shival Salgaonkar
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Ireland
| | - Gerard T Flaherty
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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19
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Medical Tourism in Aesthetic Breast Surgery: A Systematic Review. Aesthetic Plast Surg 2021; 45:1895-1909. [PMID: 33876284 PMCID: PMC8054849 DOI: 10.1007/s00266-021-02251-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/16/2021] [Indexed: 02/07/2023]
Abstract
Introduction Medical tourism is expanding on a global basis, with patients seeking cosmetic surgery in countries abroad. Little information is known regarding the risks and outcomes of cosmetic tourism, in particular, for aesthetic breast surgery. The majority of the literature involves retrospective case series with no defined comparator. We aimed to amalgamate the published data to date to ascertain the risks involved and the outcomes of cosmetic tourism for aesthetic breast surgery on a global basis.
Methods A systematic review of PubMed, Google Scholar, EMBASE, the Cochrane library and OVID Medline was conducted using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines. Keywords such as “medical tourism”, “cosmetic tourism”, “tourism”, “tourist”, “surgery”, “breast” and “outcomes” were used. Seven hundred and seventy-one titles were screened, and 86 abstracts were reviewed leaving 35 full texts. Twenty-four of these met the inclusion criteria and were used to extract data for this systematic review. Results One hundred and seventy-one patients partook in cosmetic tourism for aesthetic breast surgery. Forty-nine percent of patients had an implant-based procedure. Other procedures included: mastopexy (n=4), bilateral breast reduction (n=11) and silicone injections (n=2). Two-hundred and twenty-two complications were recorded, common complications included: wound infection in 39% (n=67), breast abscess/ collection in 12% (n=21), wound dehiscence in 12% (n= 20) and ruptured implant in 8% (n=13). Clavien–Dindo classification of the complications includes 88 (51%) IIIb complications with 103 returns to theatre, 2 class IV complications (ICU stay) and one class V death of a patient. Explantation occurred in 39% (n=32) of implant-based augmentation patients. Conclusions Aesthetic breast surgery tourism is popular within the cosmetic tourism industry. However, with infective complications (39%) and return to theatre rates (51%) significantly higher than expected, it is clear that having these procedures abroad significantly increases the risks involved. The high complication rate not only impacts individual patients, but also the home country healthcare systems. Professional bodies for cosmetic surgery in each country must highlight and educate patients how to lower this risk if they do choose to have cosmetic surgery abroad. In this current era of an intra-pandemic world where health care is already stretched, the burden from cosmetic tourism complications must be minimised. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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20
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O’Sullivan D, McCabe JP, Flaherty GT. Orthopedic Tourism and Volunteerism: Joint Effort or Disjointed Mobility? Arthroplast Today 2021; 10:114-116. [PMID: 34345641 PMCID: PMC8319507 DOI: 10.1016/j.artd.2021.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/12/2021] [Accepted: 06/16/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- David O’Sullivan
- Department of Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - John P. McCabe
- Department of Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Gerard T. Flaherty
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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21
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Yang YT, Hsu YHE, Tang KP, Wang C, Timmon S, Chiu WT, Annavajjula S, Chu JS. Case study: international healthcare service quality, building a model for cultivating cultural sensitivity. Int J Qual Health Care 2021; 32:639-642. [PMID: 32860683 DOI: 10.1093/intqhc/mzaa097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/19/2020] [Accepted: 08/15/2020] [Indexed: 11/14/2022] Open
Abstract
QUALITY PROBLEM OR ISSUE In the context of medical tourism, cultural differences and language barriers are unneglectable factors, which compromise the shared decision-making between doctor and patients. INITIAL ASSESSMENT This study constructs a cultural sensitivity cultivation (CSC) model that could be used to train medical professionals in the sector of medical tourism. CHOICE OF SOLUTION Since 2016, there have been explorations in new strategies to offer better services. A critical step added is to include clients' perspectives in the re-examining process as a way to cultivate cultural sensitivity among the service providers. This practice expands to the sector of medical tourism. In our case study, we are able to conclude a new model that could yield quality international healthcare services. IMPLEMENTATION The steps of our CSC model include (i) 'Promote Awareness' for shifting mindset, (ii) 'Share Scenarios' for developing empathy and compassion, (iii) 'Review Process' for collecting detail feedback, (iv) 'Identify Gaps' for targeting areas for improvement and (v) 'Improve Systems,' for changing standard operation procedures (SOPs) based on the strategies through Assmann's theory with a cultural-anthropological approach. EVALUATION After Kuang Tien General Hospital (KTGH) implemented the new model for 1 year, the number of international patients has increased by 64%. More research could be done in the future to cover all the important aspects of providing international medical services and could apply the CSC model to different healthcare settings. LESSONS LEARNED To optimize the shared decision-making between the doctor and medical traveler patients, healthcare providers should not only overcome language and cultural barriers but also should avoid unnecessary gestures in terms of status respect. Inviting patients to be co-investigator for quality improvement is a viable solution.
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Affiliation(s)
- Ya-Ting Yang
- i-College, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hsin Elsa Hsu
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.,Executive Master Program of Business Administration in Biotechnology, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Kung-Pei Tang
- Department of Humanities in College of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Stephen Timmon
- University of Nottingham, School of Health Sciences, Nottingham, Nottinghamshire, UK
| | - Wen-Ta Chiu
- Alhambra Hospital Medical Center, California, USA
| | | | - Jan-Show Chu
- Department of Pathology in College of Medicine, Taipei Medical University, Taipei, Taiwan .,Department of Pathology, Taipei Medical University Hospital, Taipei, Taiwan
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22
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Population-based surveillance of medical tourism among US residents from 11 states and territories: Findings from the Behavioral Risk Factor Surveillance System. Infect Control Hosp Epidemiol 2021; 43:870-875. [PMID: 34261562 DOI: 10.1017/ice.2021.245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To describe medical tourism among a subset of US residents; identify possible indicators for medical tourism. METHODS The US Centers for Disease Control and Prevention collaborated with 11 states and territories to ask 6 questions about medical tourism, using the Behavioral Risk Factor Surveillance System. Data collected from January 1, 2016, through December 31, 2016, included whether respondents traveled internationally for preplanned care, travel reasons and destinations, procedures received, and occurrence and treatment of complications. A descriptive analysis of demographics, socioeconomic status and health access variables was performed, and a regression model with a log-link function and Poisson distribution was used to estimate prevalence ratios (PR) for medical tourism. RESULTS Of 93,492 respondents, 517 (0.55%) traveled internationally during the previous year for care. Mexico was the most common destination (41% of trips). Dentistry accounted for 55% of treatments. Complications from care received abroad were reported by 5% of medical tourists; 67% sought care upon returning to the United States. The prevalence of medical tourism was 1.32% (95% CI, 1.00-1.64). The prevalence of medical tourism was higher in Hispanics and non-whites (PR, 3.97; 95% CI, 2.48-6.32) and higher among those without current health insurance (PR, 2.70; 95% CI, 1.69-4.34). CONCLUSIONS This is the largest collection of population-based surveillance data describing medical tourism among US residents from multiple states and territories. Understanding the demographic and socioeconomic factors associated with medical tourism can inform evidence-based recommendations for travelers and clinicians who may advise or care for these individuals before, during, or after travel.
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23
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Pavli A, Maltezou HC. Infectious complications related to medical tourism. J Travel Med 2021; 28:5959955. [PMID: 33159509 DOI: 10.1093/jtm/taaa210] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Medical tourism has been increasing dramatically globally, with people travelling from developed countries to low-income or middle-income countries, often to avoid high costs or long delays associated with seeking healthcare in their countries of origin. The current review summarizes healthcare-related infections associated with medical tourism, focusing on cosmetic surgery and organ transplantation. METHODS A systematic MEDLINE and PubMed search from January 2010 to December 2019 yielded 80 relevant articles, including 49 articles on medical tourism-related infections focusing on cosmetic surgery and organ transplantation, which were included in this reviews. RESULTS The literature reveals specific types of cross-border, healthcare-related infections depending on medical intervention. Destinations include low-income countries such as countries of Asia and the Indian subcontinent, middle-income countries including Central and South America, and high-income countries such as the United States and Europe. In terms of type of infections, in 36 (68%) and 15 (28.3%) studies, wound and blood-borne infections were documented, respectively, while in 21 studies (58.3%) non-tuberculous mycobacteria were isolated, including Mycobacterium abscessus, Mycobacterium chelonae, Mycobacterium senegalense and Mycobacterium fortuitum. The choices of medical tourists could have significant consequences for them and their home countries, including infectious complications and importation of pathogens, particularly antibiotic-resistant microorganisms, with public health implications. CONCLUSIONS There is a need for public health strategies in order to prevent morbidity and mortality as well as future management and education of patients engaging in medical tourism.
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Affiliation(s)
- Androula Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
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24
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Wilder-Smith A, Osman S. Public health emergencies of international concern: a historic overview. J Travel Med 2020; 27:6025447. [PMID: 33284964 PMCID: PMC7798963 DOI: 10.1093/jtm/taaa227] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 12/19/2022]
Abstract
RATIONALE The International Health Regulations (IHR) have been the governing framework for global health security since 2007. Declaring public health emergencies of international concern (PHEIC) is a cornerstone of the IHR. Here we review how PHEIC are formally declared, the diseases for which such declarations have been made from 2007 to 2020 and justifications for such declarations. KEY FINDINGS Six events were declared PHEIC between 2007 and 2020: the 2009 H1N1 influenza pandemic, Ebola (West African outbreak 2013-2015, outbreak in Democratic Republic of Congo 2018-2020), poliomyelitis (2014 to present), Zika (2016) and COVID-19 (2020 to present). Poliomyelitis is the longest PHEIC. Zika was the first PHEIC for an arboviral disease. For several other emerging diseases a PHEIC was not declared despite the fact that the public health impact of the event was considered serious and associated with potential for international spread. RECOMMENDATIONS The binary nature of a PHEIC declaration is often not helpful for events where a tiered or graded approach is needed. The strength of PHEIC declarations is the ability to rapidly mobilize international coordination, streamline funding and accelerate the advancement of the development of vaccines, therapeutics and diagnostics under emergency use authorization. The ultimate purpose of such declaration is to catalyse timely evidence-based action, to limit the public health and societal impacts of emerging and re-emerging disease risks while preventing unwarranted travel and trade restrictions.
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Affiliation(s)
- Annelies Wilder-Smith
- Global Health and Epidemiology, University of Umea, 901 87 Umea, Sweden.,Heidelberg Institute of Global Health, University of Heidelberg, Im Neuenheimer Feld 365, 6900 Heidelberg, Germany
| | - Sarah Osman
- Global Health and Epidemiology, University of Umea, 901 87 Umea, Sweden
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25
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Yam ELY. COVID-19 will further exacerbate global antimicrobial resistance. J Travel Med 2020; 27:5857111. [PMID: 32539142 PMCID: PMC7313869 DOI: 10.1093/jtm/taaa098] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Esabelle Lo Yan Yam
- College of Health and Medicine, Australian National University, Canberra, ACT 2600, Australia
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Coutrot IP, Smith R, Cornelsen L. Is the rise of crowdfunding for medical expenses in the United Kingdom symptomatic of systemic gaps in health and social care? J Health Serv Res Policy 2020; 25:181-186. [PMID: 31992082 DOI: 10.1177/1355819619897949] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Crowdfunding for medical care is a new phenomenon but increasingly used by individuals to seek financial help to cover the costs of health care. Ethical concerns have been raised about medical crowdfunding, including implications for equity, resource allocation, medical decision-making, the promotion of non-evidence based therapies, platforms' lack of transparency and corporate interests. Medical crowdfunding efforts may point to shortcomings in health service provision, but they tend to have wider motivations and implications. However, there is no firm evidence base for establishing answers to even the most basic questions, such as who is seeking funds, for what, where and why. In this Essay, we provide an introduction to medical crowdfunding in the United Kingdom (UK). We synthesize what is currently known and the insights that might be gained from an exploratory review of 400 medical crowdfunding campaigns on the GoFundMe UK website: for instance, whether medical crowdfunding occurs in response to gaps in service provision, supports 'queue jumping' and how it relates to 'medical tourism'. We conclude with a call for research on medical crowdfunding in the UK (and elsewhere) as a means to better understand patients' perceived or actual unmet need for health and social care and inform policy development.
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Affiliation(s)
- Isabel Pifarré Coutrot
- MSc PH Student, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
| | - Richard Smith
- Deputy Pro Vice Chancellor and Professor in Health Economics, College of Medicine and Health, University of Exeter, UK
| | - Laura Cornelsen
- Assistant Professor in Health Economics and MRC Career Development Fellow, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
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